DEA Announces Policy Change Recognizing Long-Term Care Nurses As Agents Of The Prescriber

12 Oct 2010   

The American Society of Consultant Pharmacists (ASCP) has succeeded in its advocacy efforts seeking relief for nursing facility residents who encounter delays in access to prescribed medications subject to regulation under the Controlled Substances Act. In a Federal Register notice published recently, the Drug Enforcement Administration (DEA) announced internal policy changes that will now recognize nurses who work in long-term care facilities as agents of physicians who prescribe certain medications regulated under the Controlled Substances Act.

"For many years, ASCP has led the long-term care industry in its pursuit of changes to DEA policies that create delays for dispensing controlled prescription medications destined for residents in long-term care facilities," said ASCP President-Elect Albert Barber, PharmD, CGP, FASCP. "We commend the DEA for clearing the way for improved quality care for patients."

The Federal Register Notice reiterates DEA's definition of an agency relationship as it pertains to a practitioner and those duties that can be delegated to another individual. The notice expands upon DEA's expectations for establishing agency through a series of recommendations, including establishing written agreements between practitioners and nurses who wish to establish an agency relationship. Once an agency relationship is established, a nurse at a long-term care facility acting as the agent of a prescribing practitioner may communicate to a pharmacy prescription orders for Schedule C-III, C-IV, and C-V medications.

"By allowing the long-term care nurse to serve as an agent of the prescribing physician, orders for C-III through C-V controlled medications can be communicated to the pharmacy in a more efficient and timely manner. Patients will now be at a much lower risk of encountering delays for medications to alleviate their pain," says Barber.

On August 30, ASCP submitted comments responding to a June 29 DEA Request for Information Federal Register Notice, in which DEA sought public comments related to dispensing controlled medications in the long-term care setting and possible regulatory changes within the framework of the Controlled Substances Act. ASCP sought legislative or regulatory changes to the Controlled Substances Act that would:

Provide nurses authority to transmit chart orders as valid prescriptions to pharmacies for dispensing

Provide pharmacists the ability to generate pre-populated fax-back forms for Schedule II medication orders to be signed by the prescribing physician and file as a valid prescription

Allow all emergency or contingency supplies of controlled medications stored onsite at a long-term care facility to remain part of the inventory of the pharmacy

This stunning turn of events follows a marked change in DEA enforcement policy within the last 18 months, which led to increased enforcement activities in long-term care facilities and pharmacies in Ohio, Wisconsin, and Virginia. In an effort to comply with DEA's new policy interpretation, widespread changes in long-term care pharmacy practice resulted in delays of appropriate treatment for patients where a controlled medication is indicated.

The multi-stakeholder group Quality Care Coalition for Patients in Pain, led by ASCP, commissioned a study, "Patients in Pain: How the U.S. Drug Enforcement Administration Rules Harm Patients in Nursing Facilities." The study identified the impact of delays for controlled medication dispensing on patient care quality. In response to industry concerns, Senator Herb Kohl [D-WI] hosted a "listening session" before the Senate Special Committee on Aging, during which ASCP provided expert witness testimony on behalf of long-term care pharmacy and the findings of a nationwide survey of clinicians serving patients in long-term care.

The American Society of Consultant Pharmacists (ASCP) is the only international professional society devoted to optimal medication management and improved health outcomes for all older persons. ASCP's members manage and improve drug therapy and improve the quality of life of geriatric patients and other individuals residing in a variety of environments, including nursing facilities, subacute care and assisted living facilities, psychiatric hospitals, hospice programs, and home- and community-based care.

Source:
American Society of Consultant Pharmacists